Bumps, boobs & bouncing back
An athlete's path through pregnancy
By Sonia Oxley & Andrew Aloia
Bounce back. It sounds so easy.
As if inflating your tummy to 20 times its normal size, growing an actual human being in there and then delivering all 8lbs of it safely into the world through a small hole leaves your body exactly the same as it was nine months earlier.
As simple as chucking a new football against a wall and watching it bounce back as perfectly round as when it left your hands. When, in fact, you鈥檒l be lucky if it comes back even remotely looking like a battered rugby ball.
With Serena Williams having had her baby, attention is now focused on when the former world number one will return to tennis and start adding to her 23 Grand Slam singles titles. She has been training through pregnancy and there are plenty of examples of athletes winning less than a year after having a baby - such as Jessica Ennis-Hill鈥檚 world heptathlon gold and Paula Radcliffe鈥檚 New York Marathon victory.
But how exactly do they get to that point if their well-honed bodies have been stretched, torn and flooded by hormones?
This is not about juggling night feeds, nappies and a career - the things a male athlete who is a parent can also go through. This is about running while being kicked in the ribs, dashing to the loo during training and swapping a six-pack for a big balloon while still managing to do squats.
This is about having stitches in your nether regions and wet patches on your vest that haven鈥檛 come from sweat. This is about keeping your mind focused on a gold medal while you can鈥檛 see your toes over your belly.
The first
trimester
you鈥檙e pregnant. You take a few
(dozen) more tests just to make sure,
then cry, laugh, panic, celebrate鈥
and then you start to plan.
But you鈥檙e not planning which ice
cream flavours to stock the freezer
with or what colour to paint the
nursery, this is a training plan that
takes you from the blue line in the
window back to the podium 鈥 most
likely via some stitches, leaky
boobs, decimated abs and a saggy
pelvic floor.
And more trips to the toilet than you
ever thought were possible.
Sarah Storey, the swimmer turned cyclist and Britain鈥檚 most successful Paralympian, is expecting her second child in the autumn.
鈥淚 don鈥檛 think you have maternity leave as an athlete," she said. "It鈥檚 completely impractical to be off training for as long as a year, so you are continuing to train towards that goal of Tokyo [2020 Paralympics] in this case.
鈥淏ut you are adjusting your training load according to your circumstance, just as you would if you had another physical challenge like injury.鈥
The first 12 weeks are when you are most likely to suffer with morning sickness, have sore breasts, a surge in the hormone that relaxes ligaments and increases blood flow (relaxin) - and yet no bump that gives the game away to others.
鈥淢y boobs were really tender. That was the first sign that I was pregnant with [first child] Isla. I鈥檓 used to not really needing to bother with a sports bra so I did have to do that,鈥 world marathon record holder Paula Radcliffe told 大象传媒 Sport.
I thought: 鈥極h no, everyone鈥檚 going to know I鈥檓 pregnant, they just need to look at me.'
Some might not even know they are pregnant at this stage, with Ennis-Hill training as normal for around the first two months as she had no idea she was expecting.
Others change their approach from the moment they decide to try for a baby.
鈥淚 treated myself the same way as if I was pregnant,鈥 said 2014 European 10,000m champion and mum of two Jo Pavey.
鈥淚 wouldn鈥檛 want to be pushing myself to the absolute maximum - where you are lying on the floor at the end of each session - if I鈥檓 aware that there could be a developing foetus.鈥
NHS guidelines state that exercise during pregnancy can be beneficial in terms of helping women cope with labour and get back into shape afterwards. The advice is not to exhaust yourself or get overheated and not suddenly take up strenuous exercise if you were not active before.
But what if you are used to pushing yourself to your physical limit?
Michael Dooley, consultant gynaecologist at King Edward VII's Hospital in London, said: 鈥淭he question you are asking is, 鈥榳hat is the difference between driving around the streets of London on a Sunday jaunt compared to being a Formula 1 driver racing at Silverstone?鈥
鈥淵ou are doing the same thing, but you are doing it at a different level. You are at a different level of training, physical ability, mental ability and risk.
鈥淭hey are both cars but are completely different - and because they are completely different you have to have different ways of handling them.
鈥淭he machine has to be much more finely tuned; an elite athlete, in her own body has to be more finely tuned. She is going to be much more aware of her body because she is going to be listening to her body, just as a Formula 1 car would have more monitors on it than a Fiat would be going around town.鈥
Take heart rate, for example. The formula often used to calculate a woman鈥檚 maximum heart rate is 206 minus 88% of their age, so a 30-year-old woman鈥檚 maximum rate would be around 180 beats per minute (bpm).
However, Radcliffe - who was 33 when she had Isla - was advised that during pregnancy the level she could work at was up to 180bpm because she had a maximum heart rate of 205bpm as an elite athlete.
While foetal heart rates are impossible to monitor during training, International Olympic Committee studies have concluded there is little risk of an abnormal response if athletes exercise at less than 90% of their maximum heart rates in the second and third trimesters.
To 鈥榦rdinary people鈥, the levels of training elite athletes do during pregnancy may seem mind-blowing. Radcliffe ran twice a day - for about 45 minutes in the mornings and 30-40 minutes in the afternoons - all the way through her second pregnancy, while Storey cycles for about three hours a day.
鈥淯p to 12 weeks the pelvis is protecting you,鈥 said Dooley. 鈥淭he woman would feel it but you wouldn鈥檛 notice it.
"After about 12 weeks it begins to come out, but there are significant physiological changes going on in their bodies.鈥
your baby is starting
to look like a small
person, with eyes and
ears now formed.
They will be able to fit in
the palm of your hand
and, weighing in at
roughly 10g, your baby
is about twice as heavy
as a shuttlecock.
Footballer Sarah Wiltshire was playing for Yeovil Town all the way through her first trimester last July, while Storey said she was 鈥渁 little bit pregnant鈥 when she did the National Track Championships at the end of January this year.
鈥淚鈥檇 already committed to a few road time trial events due to start racing before the 12 weeks when you would normally tell people, so I did race during that period,鈥 said Storey.
"I played up to 13 weeks and the last game - I knew it was time," added Wales striker Wiltshire.
"It was a tough game physically and there were a few fouls on me. I thought, 鈥榥o, this needs to stop here鈥.
"I was in constant contact with the club doctor and went off what he was advising as well.鈥
Many women wait until their 12-week scan - the first scan routinely offered on the NHS - to share the news they are pregnant, but for a sportswoman this approach could be dangerous, according to Dooley.
鈥淚f they then had an accident there can be unknown danger,鈥 he said. "I was involved in one case where they had a horrendous riding accident, the conception was concealed.
鈥淭hank goodness everything was all right, but if she had become unconscious we would have not have known she was pregnant - she could have had a ruptured ectopic pregnancy and we could have run into all sorts of problems and completely missed the diagnosis.
"What we don鈥檛 want is athletes concealing.
What I鈥檝e had a few times in competition is people who were terrified about telling the team that they were pregnant because they may lose their position.
Dooley, who worked with Radcliffe during her pregnancies, said the main thing is to treat an athlete鈥檚 pregnancy as a 鈥渘ormal event鈥 and for the women to tell their coaches confidentially about it and devise a strategy.
鈥淎ll governing bodies should have a policy, but sadly this is not the case,鈥 said Dooley.
Falls from bikes and horses, and collisions in football and rugby are all obvious risks, while there is also the potential of injury in any sport because of the relaxin hormone that increases the stretchiness of tendons and ligaments.
鈥淵ou know it because you can feel the way your ankle moves and you don鈥檛 want it to separate,鈥 said Storey.
鈥淚f the gears are too big and you get out of the saddle and try to put in too much of an acceleration the hormone can potentially cause damage to joints that are a bit vulnerable.鈥
Those issues aside, early pregnancy can provide some performance benefits.
Professor Greg Whyte, a physical activity expert and author of pregnancy exercise book 'Bump It Up', said: 鈥淭here is an increase in blood volume, increase in blood cell mass - red blood cells carry oxygen so actually you can improve your aerobic capacity.
鈥淚n the first trimester, when the foetus is tiny, there are no real changes in weight and no biomechanical changes. They can increase aerobic capacity, they can run faster, swim faster, cycle faster.鈥
None of this is much use, though, if you are feeling tired, sick and moody - making it, in Dooley's words, 鈥減erformance neutral鈥.
Morning sickness - just as likely to hit in the afternoon - requires hospital treatment for some women, and is suppressible with a snack for others.
鈥淪ome people who don鈥檛 eat when they are hungry maybe feel sick more frequently but I鈥檝e never been afraid to eat,鈥 said Storey. 鈥淚 know that鈥檚 a real taboo subject with a lot of athletes.
鈥淵our race weight is 6kg to 8kg lighter than the average person of your build in 鈥榬eal life鈥. Any weight you are putting on is just to get you to the normal - you have to accept you鈥檙e in the super-skinny category, so you have to be really careful that you don鈥檛 give yourself a hard time.
In my first pregnancy, I was 66kg when I raced in London and Rio, but I came out of hospital with a baby and I was still 92kg!
鈥淏ut I was fit and healthy. Some of that weight was extra muscle - as I trained right the way through pregnancy, I gained muscle in my legs.鈥
Putting on weight and changing shape when you are used to strictly monitoring body fat percentages, water and muscle mass can take some getting used to, but for some athletes pregnancy is instead a liberating experience.
Psychologist Britt Tajet-Foxell, who has worked with the Norwegian Olympic Association and various ballet troupes, said: 鈥淭hey step into this world of being pregnant that every other woman who has been pregnant also steps into. Maybe that period is the first very normal period they go through.
鈥淚f they have been top of their game for a period of time, them going into pregnancy is something that most seem to enjoy.鈥
by posing naked for Vanity Fair at
seven months pregnant.
According to a friend quoted in the
magazine article, the American, who
turns 36 in September, loved being
pregnant.
Williams has said she expects to
return to the pro tennis circuit in
January because "I don't think my
story is over yet".
The second
trimester
the 鈥榥ice鈥 period of pregnancy.
You feel less sick, you can still see
your toes over your bump and you
may have more energy.
But where鈥檚 the six-pack gone?
No, it鈥檚 not a boob job.
And you鈥檙e not slacking off in training...
in fact, you鈥檙e training for two!
鈥淢y gynaecologist scared the hell out of me when we met when I was five months,鈥 said Radcliffe.
鈥淲e were filling in forms and she said: 鈥榃hat do you do now?鈥 I鈥檓 a marathon runner. 鈥楤ut you鈥檙e not training now?鈥 Well, yeah, actually I was at the track this morning doing some easy 400s.
鈥溾橭h no, that鈥檚 really irresponsible, you鈥檙e going to have shortened your cervix, you鈥檙e going to give birth really early鈥 and all these scare stories. 鈥楶lease come back tonight and I鈥檓 going to measure the length of your cervix to make sure鈥.
鈥淓verything was A perfect. She was really nice and when I gave birth she came into the ward and said: 鈥業 want to apologise for scaring you then - I鈥檓 now going to tell all my mothers who are active to carry on with some modification of that activity.鈥欌
There are plenty of examples of sportswomen still competing at this stage of pregnancy.
Dutchwoman Anky van Grunsven won Olympic dressage gold while five months pregnant in 2004, while images of Alysia Montano competing in the USA Track and Field Championships at the same stage in 2014 are also an amazing illustration of this.
Five months after Williams won the Australian Open, Mandy Minella appeared in the first round of Wimbledon while four and a half months pregnant.
However, by now many athletes are just focused on keeping up their fitness.
鈥淵ou want to maintain, you wouldn鈥檛 want to put on an excessive amount of weight,鈥 said sports gynaecologist Dooley, who is teaming up with colleagues to set up a national institute for women鈥檚 health and performance.
鈥淭he biggest problem we see in non-elite athletes is 鈥業鈥檓 eating for two鈥. They then have the baby and are 10 pounds overweight and they never lose it again. There is increased risk of type 2 diabetes, increased risk of hypertension, increased risks of all sorts of problems.鈥
Maintaining fitness during pregnancy can throw up challenges though.
鈥淚鈥檇 just have to find a bush or tree,鈥 said Pavey, remembering the desperate-for-the-loo feeling that pregnancy so often brings as baby and organs vie for space in a crowded area near the bladder.
To make sure she and her baby stayed comfortable in other ways during training, she wore a heart rate monitor, trained at cooler times of the day, made sure she was hydrated, took a phone and energy gel with her and avoided rough ground to minimise the risk of falling.
In some ways, athletes lead the ideal lifestyle for pregnancy.
鈥淭hey are not smokers, they are not drinkers, they do have a healthier diet, they are physically active and, to some extent, they have a very stable environment in which they live,鈥 said Whyte, a two-time Olympian and World and European Championship medallist in modern pentathlon.
Effectively, they are not making any major changes to their lifestyle. What they are doing is maintaining their lifestyle.
Even their cravings sound healthy.
鈥淚 just couldn鈥檛 be hungry, I ate a lot of fruit,鈥 said Radcliffe. 鈥淚 had a bit more of a chocolate craving with [second child] Raphael and also Marmite.
"I must鈥檝e been craving B vitamins. I used to sleep with a banana by the side of my bed so if I woke up hungry I could have a couple of bites.鈥
Williams' fiance Alexis Ohanian revealed in August that his partner's pregnancy cravings included courgette, asparagus and artichoke.
weeks you're now
halfway through
the pregnancy!
Measuring 25cm, your
baby is nearly as long
as a rugby ball and, at
400g, is about as heavy
as one too.
For elite athletes, it is more about listening to their bodies and adapting the tools for their job than making lifestyle changes - tweaking the settings on their bikes, altering their pace, getting a sports bra, lifting lighter weights at the gym or wearing a sacroiliac belt to support the bump.
鈥淚鈥檓 very much into pregnancy pace now,鈥 Storey said when she was about five months pregnant.
鈥淢y handle bars have come up on the stacker, so you are basically accommodating the bump. With that you have to be careful on descent because you鈥檝e not got as much weight on the front wheel, so the handling of the bike changes.鈥
The second trimester is when women usually start to feel the baby move and the growing bump can begin to affect balance.
鈥淚t鈥檚 more the muscular balance that you鈥檒l feel,鈥 said Radcliffe. 鈥淵our glutes might work harder one day and you change a bit in terms of how you throw your arms out - but it鈥檚 not because of the weight, it鈥檚 because the baby moves.
鈥淒epending on how they are sitting it鈥檚 a totally different sensation so you just have to be very adaptable about it and relaxed. With Isla, I used to wake up in the morning and see what kind of position she was in and what kind of training I was going to do.鈥
According to professor Whyte, around 80-90% of pregnant women complain of lower-back pain because of their change in posture, caused by the bump and bigger breasts - breasts that, according to Dooley, travel quite some distance if unrestrained.
If you run a mile [without a bra], your breasts move up and down 100 yards.
鈥淚f they are training, proper sports bras and proper training kit are important as there is soreness they may experience.鈥
While maternity sportswear does exist, some athletes choose to improvise.
鈥淚 tended to wear cycling-type shorts. Sometimes I鈥檇 just roll them down a bit so that the band was under the bump if it wasn鈥檛 stretchy enough,鈥 said runner Pavey.
鈥淎nd I鈥檇 wear two or three crop tops - larger size ones. Sometimes I wore three it was so painful. I started off wearing large T-shirts but then it just got to me wearing my husband鈥檚 running T-shirt.
鈥淚 needed to use a lot of Vaseline around the crop tops. They [breasts] still bounce up and down - it was just rubbing holes in my skin.鈥
The third
trimester
You鈥檙e being elbowed in the ribs and
kicked in the bladder, you feel like
your skin can鈥檛 possibly stretch any
more without everything exploding
and you鈥檝e sprung a few leaks from
private parts of your body.
You stay focused and keep training
because the good news is you鈥檝e
been told: 鈥業f you can run a marathon,
giving birth will be easy.鈥
But will it?
鈥淵ou鈥檇 get people shouting: 鈥榊ou鈥檙e so selfish, why would you think of doing that?鈥" said Radcliffe, who ran right up to her due date and for the two weeks she went over with her first.
鈥淵ou do just want to turn round and say: 鈥楢ctually, it might be healthier than the one who is sitting at home with her feet up eating ice cream for the whole pregnancy.鈥 But you can鈥檛.
鈥淏ut most people are quite supportive. I got a lot of double-takes as I was running in the park.鈥
She said she was once doing hill reps in the park when she was stopped by a man walking a dog.
鈥溾橠oes your doctor know you are doing this?鈥 Yes, it鈥檚 OK, they know. 鈥業f it鈥檚 all the same to you, I鈥檓 going to wait until you鈥檝e finished to make sure you are OK.鈥
鈥淚 had to take Isla back to see him and we still see him and she says: 鈥楾hat鈥檚 the man who was worried about me when I was in your tummy.鈥欌
She also raised eyebrows in the gym.
鈥淚 was doing squats. If you walked in behind you wouldn鈥檛 see anything - and then I鈥檇 rack the bar and turn round and they would freak out. I wasn鈥檛 lifting heavy.鈥
Radcliffe said she had extra scans during her first pregnancy - one every month from five months - to make sure everything was going well, but she just had the usual 12-week and 20-week scans during her second.
鈥淭raining through the second one is much easier because you鈥檝e had that reassurance and kind of belief that what you did was right,鈥 she said.
鈥淭hey slept when I ran. I would feel the kicking afterwards and that鈥檚 very reassuring. Occasionally I鈥檇 get a kick in the ribs [while running] which really, really hurts. If they kicked, I鈥檇 just walk for a bit until they got comfortable.鈥
now entering the home
straight and it's time to
start working on your
birth plan.
Your baby, who you can
feel kicking, weighs about
2.2kg - which is heavier
than a men's discus.
The sight of Malaysian shooter Nur Suryani Mohamed Taibi at the London 2012 Olympics while eight months pregnant made headlines at the time.
鈥淎 sport like shooting can continue,鈥 said Whyte. 鈥淚nvariably, you see people in the third trimester with a change of gait. Biomechanically you change how you walk, how you cycle.鈥
With the focus now turning to the impending birth, athletes will be considering the type of birth they might want from both a personal and professional point of view.
鈥淪ome sports are quite keen on Caesarean sections because if you are sitting down - maybe riding a bike or a horse - and you have a badly damaged perineum, it may be difficult,鈥 said consultant Dooley.
鈥淗aving a Caesarean section should not be thought of as being detrimental if that is the right thing for them and the baby.
When you are looking after an athlete you are dealing with a mother and child. Not a mother, child and athlete.
Recovery from a C-section is usually longer than from a vaginal birth - you cannot drive for six weeks - and some athletes are keen to avoid one so they can resume training sooner.
鈥淚 was pretty blinkered the first time round. I really wanted to not have a Caesarean but because I have a narrow pelvis I was on the watch list for one,鈥 said Radcliffe, who was induced for her first baby.
She ended up having an epidural because, although she was only 1.5cm dilated, she was having the type of contractions more usual at 9cm. And she believes that was because she was an athlete.
鈥淚 didn鈥檛 want to do that [have an epidural] because I was scared of losing the feeling down my legs.
I had to sit cross-legged for 14 hours overnight just to let the muscles relax and dilate enough for her to be able to get out.
鈥淏ecause I was a Caesarean risk they would not let me eat or drink - I had an IV drip.
鈥淭hey said to me: 鈥業magine it鈥檚 a marathon, you can鈥檛 have anything until you finish.鈥 And I was like: 鈥楴o, you can drink every 5k!鈥
鈥淏ecause I was an athlete, my muscles were so tight and she was struggling to get out - but I had more stamina and more endurance to be able to push to get her out.鈥
After 26 hours, an episiotomy - a cut between the vagina and anus sometimes given to avoid a tear - and a low ventouse, Radcliffe delivered Isla.
Storey ended up with a C-section, which put paid to her original idea that she might be able to compete at the World Championships two months after giving birth.
She hopes it will be different this time round.
鈥淭here are no real reasons why I would need another one unless something went wrong. I have no desire to go through another section, but if that鈥檚 the way it happens then that鈥檚 the way it happens,鈥 she said.
Footballer Wiltshire, meanwhile, was back on the football pitch less than two months after having her baby daughter.
鈥淚 knew that having a natural birth would play a big part,鈥 she said. 鈥淭he C-section is a major operation. I started running about three weeks later so that鈥檚 the difference really. If it had been a C-section I wouldn鈥檛 have been able to do anything for six weeks.鈥
Being in labour has often been likened to running a marathon, so if anyone can shed light on whether this is true, it is Radcliffe.
鈥淚t doesn鈥檛 compare at all,鈥 she said. 鈥淚t鈥檚 a completely different type of pain.
鈥淲hen you鈥檙e running you are trying to push your body as hard as you can and switch off everything that鈥檚 telling you it hurts - but you know that at any moment, if it gets too much, you can just stop. You can鈥檛 do that when you鈥檙e giving birth, you鈥檝e got to get the baby out.
鈥淚t鈥檚 a lower level of pain but it鈥檚 sustained for much longer. It was only when pushing I thought this is kind of similar - you get into a rhythm and you can push with rhythm. Breathing techniques you learn for pain management while you鈥檙e running or getting physio really help when you鈥檙e giving birth.鈥
Athletes can be better prepared for delivery because they are so fit, says professor Whyte.
鈥淭here is a lot of talk about the pelvic floor. It is fundamental. What athletes have is a very good control over the muscle,鈥 he said.
鈥淚f you have maintained your core strength and stability through pregnancy, when a midwife says push, the amount of force you produce is greater.鈥
Because no-one knows what their labour and birth is going to be like, it is hard to plan what happens next.
Ennis-Hill鈥檚 coach Toni Minichiello said he was never convinced she was coming back to competition, despite her insistence throughout her pregnancy that she would.
鈥淚 didn鈥檛 believe her, let鈥檚 put it that way,鈥 he said. 鈥淚 know you鈥檙e telling me at this moment in time - but not even you can answer that question until the little one arrives.
鈥淚t also depends on how straightforward the birth is. We had an expression: it just depends whether the baby comes out of the tunnel or out of the chute!鈥
While a Caesarean is a major abdominal operation, a vaginal delivery can also cause significant damage.
Third and fourth degree perineal tears - requiring a significant number of stitches - can leave women with both permanent and temporary bladder and bowel incontinence, while merely sitting down on a sofa can be agony for weeks. At this point, a bike saddle might seem like a medieval torture device.
The baby
and beyond
The balloons, cards and cute outfits
have poured in and you鈥檙e basking
in that new-mum glow.
While your uterus is shrinking back
from the size of a football to the size
of a golf ball and you鈥檙e bleeding gunk
for several weeks, you're also busy
feeding, burping, changing nappies,
rocking, bathing, not sleeping鈥
and training?
鈥淚 was looking at her thinking: 鈥榃ho are you?鈥 She used to be rubbish at [training on synthetic grass] and she was brilliant. I was like: 鈥榊ou can handle an extra set.鈥 The aerobic value was massive.
鈥淭he other bizarre thing is she was always stiff in the ankles, but when she came back from pregnancy that had gone. She had more range in her joints after pregnancy and that was maintained throughout.鈥
Minichiello said Ennis-Hill was benefiting aerobically from the increased blood volume and in the range of movement in her joints as a result of the relaxin, which stays in the body for up to a year post-childbirth.
Studies indicate that elite athletes who train during and after pregnancy may see a 5-10% increase in their maximal oxygen consumption in the months after giving birth, though this was not observed in recreational athletes.
What Ennis-Hill had lost, however, was speed.
鈥淗er first hill session she was at the back of the pack, whereas she would lead the pack [before]. That鈥檚 difficult to deal with when you come back.
"What鈥檚 happened to me? How far back am I? Will I ever get back? There鈥檚 a huge psyche element to that of upset.鈥
Speed is not the only thing that may have been damaged.
鈥淲hen I got back I noticed my bowel took time [to get back to normal],鈥 said Radcliffe, who returned to running 12 days after delivering her daughter and 10 days after giving birth to her son, having had an episiotomy with both.
鈥淚t took some time before I could do a half-hour run before running back into the house. It did take a good six weeks to get back. I thought it was the relaxin causing it.鈥
For some, the damage to the body from giving birth can be permanent.
鈥淪omebody I know who was a very good runner actually doesn鈥檛 want to run any more in retirement because she hasn鈥檛 got any confidence because of stress incontinence caused by childbirth,鈥 said Pavey.
How soon an athlete is ready to return to training will depend on how their birth went and how well they have settled into family life.
The worst thing you can do is have them not listen to their body. You don鈥檛 want them to say I will train tomorrow, then the baby wants to breastfeed and they have sore nipples.
Experts say the key areas to strengthen after pregnancy are the pelvic floor and the core.
All women are advised by the NHS to do their pelvic floor exercises - some are so discreet no-one knows you are doing them, some use obtrusive and hi-tech gadgets inserted into the parts that may still be tender from just having pushed out a baby.
There are apps that help you remember to squeeze, which suggests perhaps not everyone is diligently following the advice.
However, for an athlete used to following instructions, it's just another part of the training regime.
鈥淚f you tell an athlete they need to do pelvic floor exercises three times a day, they will do pelvic floor exercises three times a day. They might even do it six times a day because they have the mentality that more is better,鈥 said Whyte.
Similarly, if they have had separation of the abdominal muscles - a common problem that sometimes is never entirely fixed - they will work hard to knit them back together.
Yeovil Town player Wiltshire followed an online core stability programme, and Radcliffe did a lot of slow, sustained crunches.
鈥淪ince Raphael, I鈥檝e got a lump that pops out here,鈥 said Radcliffe, pulling up her vest to show her tummy.
鈥淚 can feel it. It鈥檚 only the size of a broad bean or something, but I can see it when I get back from a run now. If I am more dehydrated I can see this little lump. It鈥檚 just one tiny bit that hasn鈥檛 meshed together. It doesn鈥檛 look great in a bikini but other than that鈥︹
Rothstein shared candid pictures last
year of her post-partum body,
showing loose skin around her
tummy and her being able to fit three
fingers in between her two ab walls.
The American wrote in her Instagram
post: 鈥淲hen I look down I see stretch
marks that are here to stay, ab
muscles that need continued
strengthening, legs that are powerful,
and feet that are ready to fly!鈥
Whether you get stretch marks or not depends on your skin type and how elastic it is, the NHS says, and not how fit you are.
Even if they feel ready to return, athletes can sometimes pay the price for doing too much too soon.
鈥淎t eight or nine weeks post-birth I was getting to 80-90 miles a week. Then I got the stress fracture in my sacrum [triangular bone at base of spine] and that then forced me to sit out. I built up too quickly,鈥 said Radcliffe.
鈥淥nce that healed I was able to build back strongly. I learned you need to make sure your body catches up even if you feel great.鈥
She went on to win the 2007 New York Marathon 10 months after giving birth.
And she is not the only one to come back strongly, with Pavey鈥檚 career rejuvenated after becoming a mum, as well as victories in their sport鈥檚 major tournaments for the likes of tennis player Kim Clijsters and golfer Catriona Matthew.
鈥淎thletes at the top level are very much like the best ballet dancers in the world. When they have a baby, they actually come back stronger,鈥 said psychologist Tajet-Foxell.
鈥淭hey have extraordinary coping mechanisms that allow them to get back and get to an even higher level.
鈥淭hey are world beaters, really.鈥
Storey says it is up to those around the athletes to discourage them from overdoing it in their bid to return to the top of their sport.
鈥淚t鈥檚 about having a governing body that will almost hold them back a little bit and not make them start too soon,鈥 she said.
鈥淚 remember having a conversation with [former British Cycling performance director] Dave Brailsford where he said: 鈥榊ou don鈥檛 have to come back that quick - enjoy it, take your time.鈥 I realise now that鈥檚 a good thing.
You know you鈥檒l come back stronger if you do it the right way.
Whether you are breastfeeding or not can have an impact on your training, with Storey, who breastfed her daughter until she was a toddler, saying she found her energy levels depleted when she was doing both.
"When I was feeding and training, it was like in those three hours I鈥檇 done four and a half 鈥 it was like time and a half!
"When I was doing mixed feeding, the slight reduction in milk gave me extra energy.鈥
For some, breastfeeding can make training hard for other reasons.
鈥淚 wasn鈥檛 used to having a full bust. It was, should I say, leaky,鈥 said Wiltshire, who was back scoring goals a few weeks after giving birth and breastfed for four weeks. 鈥淚 felt very heavy running around. She struggled to breastfeed so it made sense for both of us to go to a bottle.鈥
And then there are the breastfeeding injuries that no-one warns you about.
鈥淚 did a lot of expressing - I wanted to breastfeed them both to six months because I鈥檓 asthmatic. I got tenosynovitis in my wrist from pumping,鈥 said Radcliffe, who stockpiled expressed milk in the freezer to make sure there was always some available if she was not around.
While some mums who return to work struggle with the guilt of not seeing their children as much as they would like or the logistics of pick-ups and drop-offs, some athletes see their careers as very child-friendly.
鈥淚 go training with my kids,鈥 said Pavey, who won her first major gold medal 10 months after having her second child.
鈥淢y little boy goes on the bike. My husband goes on the bike with our little girl on the back. Or we run and we use the running buggy. I鈥檓 starting doing a bit of running with my son.
鈥淲e鈥檝e never used a nursery for either of my children, we鈥檝e been able to juggle it between us.鈥
Radcliffe agreed, saying she was able to spend 22 hours a day with her daughter after she was born, but later faced a difficult decision of career versus child when she suffered the stress fracture.
鈥淭hey [doctors] were telling me that if you want to heal you鈥檙e going to have to stop breastfeeding,鈥 she said. 鈥淚 felt like I was making the choice [to stop at five months] because of my career.鈥
Williams and Laura Kenny have continued to train during pregnancy, committed to a return to the very top of tennis and cycling post-birth. If they need any encouragement, they could learn from Radcliffe鈥檚 words:
鈥淚 was asked: 鈥楬ow can you run, you can鈥檛 see where you鈥檙e going [over your bump]?鈥 You don鈥檛 have to suddenly look down at your feet, you are used to looking ahead.鈥